Balance Billing — Grief for Everyone
The practice of balance billing is increasing, according to this Los Angeles Times article.
Balanced billing is defined as “billing beneficiaries for amounts not reimbursed by payers (not including copayments and coinsurance amounts); this practice is prohibited by Medicare regulations,” according to “Understanding Health Insurance: a Guide to Billing and Reimbursement”, ninth edition, by Michelle Green and JoAnn Rowell.
For those who may not be familiar with the practice, here is how the article describes it:
Balance billing occurs when doctors and hospitals claim they’ve been underpaid by insurers and ask patients to pay the rest. Some patients assume — wrongly — that such bills are cleared by their insurer. For example, a doctor may charge $2,000 for a procedure, but the health plan pays $1,500. Under balance billing, the hospital would ask the patient for $500 — even though a patient had paid his or her full share of the service.
Beyond noting that it is illegal under Medicare rules, Balance Billing is, candidly, an ill-conceived practice for all concerned. While margins within healthcare are under attack for, both, insurance and providers, they are no less an issue for patients. With health care costs growing at double the rate of inflation and, more importantly, double the rate of incomes, I can think of no practice better designed to ensure the arrival of a single-payer or socialized medicine system in the United States. Balance billing is nothing less than demanding that patients pay twice for the service received, since it presents cost above and beyond their obliged deductibles, co-pays, and insurance premiums.
Recall that Medicare Part D arrived after news stories indicating that senior citizens were forgoing medications in order to heat their homes or, alternatively, eating cat food in order to afford those medications. In response, the US government spent a projected $800 billion in order to appease senior citizens on fixed incomes. Regardless of age, there is no more powerful lobbying group in the United States than patients. Among the politicians in Washington, DC, they are known by a different name – “voters.”
So, let’s consider what US healthcare would look like under socialized medicine or single-payer system. First, insurance margins would be reduced to a defined level (single payer) or would disappear entirely (socialized medicine). Second, practitioners would lose control of a significant portion of their practices. Third, patients would be constrained in their choice of practitioner and the availability of treatment.
Healthcare has long been considered a “self-regulating system.” Self-regulation, however, implies self-leadership. Historically, this is been the role and function of the American Medical Association – if not the AMA, then who? My personal view is that it is high time that the industry started to identify its own solutions to the problems that it created. Otherwise, we are destined to experience the solutions created by others who are less likely to have the best interest of patients, practitioners, and in insurance as their driving motivation
